Newborns (neonates) are prone to several problems including low blood sugar (hypoglycemia), low body temperature (hypothermia), dehydration, and aspiration pneumonia from being syringe fed or bottle fed. To help prevent hypoglycemia, be sure all newborns are fed EVERY TWO HOURS around the clock. Feeding frequency can decrease to every four hours as puppies get older. Normally, newborns will nurse off the mother's breast or the bottle until they fall asleep. Give oral 50% or 25% Dextrose (provided by your doctor) or Karo syrup by mouth (if the newborn is able to swallow) if the newborn refuses to nurse off the mother or the bottle. You can also use Nutrical, but it is thick and sometimes hard to swallow. If a newborn is unconscious from suspected low blood sugar, rub some Karo syrup or dextrose on its gums (do not place any in the throat as it may choke) right before leaving to get to a veterinarian's office. Newborns need to be fed so frequently because their livers are too immature to store large quantities of glycogen. As newborns grow, their livers get better at this and feedings can be less frequent. Safe bottle feeding is essential to preventing burns, throat infections, diarrhea, and aspiration pneumonia. Always wash bottles and nipples at least once daily with soap and water to prevent toxin build up. Bottles with formula or milk need to be kept in the refrigerator between feedings, also to slow bacterial growth and related toxin production. Run hot water over the bottle to warm up the formula before feeding - microwaving is riskier. Drip two drops of milk or formula onto the inside of your wrist before allowing the newborn to nurse, to be sure it is not too hot. Never hold a newborn on its back to bottle feed it, as this makes aspiration more likely. Aspiration can cause acute death (choking) or delayed death (pneumonia). If you suspect a newborn has aspirated, suction out the throat with a bulb syringe, 'sling' the newborn carefully (supporting the neck) as you would when getting a newborn to breathe right after delivery, and consult a veterinarian. Always keep newborns horizontal and on their breastbone when bottle feeding. Avoid using eyedroppers or syringes to feed puppies. These make aspiration much more likely. If you absolutely must use one of these, you must exercise extra caution to prevent aspiration. Place only one drop at a time on the middle of the tongue and be sure the drop has been completely swallowed before giving another. Do not place the tip of the dropper or syringe in the back of the throat. Never feed a puppy rapidly (unless it is nursing voluntarily) as overfilling the stomach will cause it to vomit and possibly aspirate. Bottle feed if the queen/dam refuses to let the puppy nurse, if the dam has suffered from eclampsia (low blood calcium), if the dam/queen is not making sufficient milk, or if the newborn is orphaned and a surrogate is not available. If possible, hold the mother down to allow the newborn to nurse without fear of injury or rejection, or if needed, milk the mother's breasts into a bottle for the newborn to drink. Sometimes giving a dam more food (use puppy food for dogs or kitten food for cats - all she can eat) and possibly an oxytocin injection can make milk available for the newborns. Keep fresh water available at all times, but be sure the newborns cannot crawl into it and drown. Mother's milk is always superior to formula. It contains antibodies that can help protect the puppies from certain infections. For weak puppies that refuse to swallow, tube feeding and subcutaneous fluids may be needed. These techniques can be taught to you by your veterinarian. Sometimes a spinal needle needs to be placed in the bone marrow of the thigh bone (femur) or shin bone (tibia) to allow fluids to be administered during hospitalization, as most newborns do not have veins accessible for IV catheter placement. Weak newborns are hard to save. Often they pass away even if all supportive techniques are performed properly. Some puppies have defects (liver shunts, cleft palates, etc.) that contribute to their demise. Cow's milk often leads to diarrhea which worsens dehydration risk. Feed formula or mother's milk. To further help prevent dehydration, subcutaneous (under the skin) fluids may be needed at home (only if demonstrated by your doctor). To prevent hypothermia, keep the newborns with the mother if possible and it is safe to do so. Keep them indoors only, in a draft free area. Orphaned or rejected newborns will need supplemental heat. Do not use an electric heating pad as burns may occur. Instead, provide thick blankets that are kept dry (check for urine frequently), and be sure the material is porous, to prevent newborns from suffocating. Do not 'pack' newborns into a bed. They need room to crawl around to cool off or breathe better if littermates are pressing on them. Also, especially for single newborns with no littermates to keep them warm, fill one or more 20 ounce soda bottles with hot water and place each in a tube sock. Alternatively, heat a Ziploc bag full of rice in the microwave for ten seconds or so and wrap it in a towel in such a way that the newborn cannot touch the plastic. Place these with the newborns so the newborns can crawl near if they are cold or get away if they get too hot. Again, newborns must have a way to escape if they are getting too hot. Always insulate heat sources so the newborn cannot touch the heat source directly. Consult your daytime doctor regarding they age they recommend starting dewormings. Some recommend dewormings start at three weeks, others at six weeks. Vaccines and heartworm pills need to be started at six weeks of age.

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